Dr. Prabha Adhikari M.R.
Professor and HOD Geriatric
Medicine
Yenepoya Medical College, Mangalore
Everybody knows that COVID-19 had a devastating effect on older adults
(age 60 years and above). Data from the Centre for Disease Control USA, WHO and
published data from China have shown that age is an independent risk factor for
COVID-19 hospitalization and death. Out
of 10 people who have died due to COVID -19, 8 are above 60 years. Also, older
individuals have multiple comorbidities which further predispose them to
hospitalizations and death. The atypical presentation and hyperimmune response also
contribute to the development of complicated COVID.
As a complication, patients with COVID have suffered from a stroke,
heart attacks and other life-threatening complications and succumbed. Few of
these complications have occurred as a delayed complication when the standard
test for COVID become negative.
Similarly, we have witnessed COVID affecting the brain, intestines,
liver, kidneys and other organs in older adults. This is because they already
have an organ which is weak and such organs are affected earlier. This is
called a weak link system. A person with chronic kidney failure will abruptly
present with worsening of the kidney disease needing dialysis. An individual
with dementia or Parkinson's disease will present with worsening of their
symptoms. Same is the status with liver disorder. These cases are not recognized
as COVID, and they succumb to the illness as -due to kidney failure, heart
failure or brain failure.
With the release of COVID-19 vaccine, the elderly have the dilemma of
taking it and exposing them to side effects or not taking it and taking the
risk of COVID morbidity or mortality. Here are answers to a few of their
questions and dilemma.
1.
Should I take
COVID-19 Vaccine?
If you are a fit older adult, you must take the COVID-19 vaccine.
If you have a comorbidity, you have to take it.
2.
The vaccine has
side effects. I am scared. My children are not allowing me to take the vaccine.
Vaccine side effect so far has been expected reactions. About one third
will experience pain at the injection site, fever, body ache. These are rarely
severe enough to confine one to bed. I was the first to be vaccinated in our
institution, and I was fine after the injection. Younger people did develop a fever
and pain. However, these symptoms will subside with paracetamol and ice pack.
3.
What about
anaphylaxis, a sudden allergic reaction?
It is a 1 in 1,00,000 reaction. All the centres are well equipped with
anaphylaxis kit which contains the antidote for the same. This reaction causes
difficulty in breathing and low blood pressure, but this is reversible with
treatment.
After vaccination, everybody is observed for 30 minutes by the medical
team as the reaction occurs within 30 minutes.
Also, the emergency team will always be ready.
4.
We heard that two
health care professionals developed a heart attack and died after vaccinations
in Karnataka.
They were investigated. They did not die immediately after vaccination. They
died after two days, and both had confirmed heart attacks. They were not
elderly.
5.
We heard that in
Norway as many as 33 elderly died after vaccination.
Two lakh nursing home residents were vaccinated. They were frail, weak,
dependent elderly. They were anyway too sick to live as the weekly death rate
among them were at least two deaths. It so happened that they died after
vaccination.
They were cleared as natural deaths by WHO
However, we will not venture and vaccinate frail elderly who are bedridden
and suffering from end-stage diseases whose life is limited anyway
6.
Which vaccine is
better?
We have two vaccines at the moment in India. Covishield made by Serum
Institute of India with the transfer of technology from Oxford University and
Astra Zeneca and Covaxin by Bharath Biotech. Both are given as two doses
Intramuscularly 28 day apart.
Antibody response and side effect profile are similar
7.
How long will I
get Immunity?
At the moment for six months for sure. It is predicted that immunity may
last up to 6 years. We are happy if immunity lasts for one year. Studies are
still ongoing
8.
If I have had
COVID and if I am living, why should I take?
If you had a mild disease in the past, there is no guarantee that the
next one will also be mild .mutations are occurring, and you can have any
number of attacks
9.
If I had COVID
when is safe to take the vaccine?
I would recommend that you had mild
COVID- you can take vaccine after 14 days after you became COVID
negative which is almost a month
If you have severe COVID-19 safer to wait for three months for all the
activated cytokines to settle
10. If I am on a blood thinner, can I take vaccination?
Suppose you are on aspirin or clopidogrel or an antiplatelet drug you
can take the vaccination. If you are on a drug called an anticoagulant, IM
Injections can make a haematoma. Hence please consult your doctor about the
safety of stopping the same
11. I have an allergy. Can I Take the vaccination?
If you have an allergy, you are at high risk of COVID complications. However,
if you had a severe allergy to any COVID Vaccination or any other vaccination, you
may opt-out of vaccination
12. Today we read that five doctors of Karnataka developed
COVID after vaccination?
Vaccination will start protection only after the second dose, that too
45 days after the second dose. Although we may upload pictures in the media
that I am safe, I am vaccinated, we need to be cautious. Vaccine efficacy is
not 100%. In studies, it will be 70-80 per cent efficacious. In the field, it
is around 60 per cent protection. All the five people were front line workers
Kindly continue to wear Mask
and maintain Physical distancing although you feel good and protected after
vaccination. We have prayed and hoped that we will get the vaccine soon. When
the vaccine has been produced by the efforts of so many, doubting rumours are
going around. All the developing countries are towards universal vaccination. We being
a vast country with a huge population we have completed 3 million vaccinations and are almost
completing the first phase, and the second phase is about to start. In the 3rd
phase, those above 50 will get the vaccination by February, March.
You will get a call and a message
about the centre before the date of your vaccination. Do not miss this
opportunity. I wish you all a Happy and safe Vaccination. Let us all be proud of the privilege of getting vaccinated at no cost.
